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United Healthcare Review from Pennsylvania

My family is insured with United Healthcare in Pennsylvania. Actually, I believe my husband's employer self-funds that plan and United Healthcare administers it. The plan covers employees in at least 25-30 states. We chose this option, because when we were self employed we had United Health One through Golden Rule and they provided good coverage for us. So we stuck with United Healthcare who’s a sister or parent company.

Plan Specifics: Our plan is a PPO, which offers increased benefits if you use a physician or provider that is part of the preferred provider network. We're very happy with the providers on the list, although one major hospital in our area pulled out of the plan last year, but now we live in Philadelphia and it seems every hospital takes our insurance. One of our doctors was affiliated with that hospital, so that was a definite drawback for us.

Copays and Deductibles: Our office visit copay is $15 for primary care providers (family doctors, pediatricians) and $25 for specialists. Until very recently the office visit copay was $10 for any kind of provider, which I realize is practically unheard of anymore. These copays only apply to visits with in network providers. We've opted for a high, $5000, deducible per family member. This keeps our premium costs lower than they otherwise would be. Since we're relatively healthy and have great office visit copays, this has worked out for us so far. We pay 10% in coinsurance once the deductible has been satisfied. The out of pocket maximum for our family is $10,000 per year, although we've never come close to meeting it.<

Our plan has a separate, emergency room deductible of $75 if it is an in network hospital. After the $75 deductible we pay 10% of the costs. The deductible is waived if we would end up being admitted to the hospital as a result of the emergency room visit. For out of network hospitals, our plan deductible of $5000 applies and we pay 10% after the deductible, assuming the visit was a true emergency. If not, we would be required to pay 30% in coinsurance after the deductible.

Lifetime Maximum Benefits: We have unlimited lifetime benefits as long as we stay within the preferred provider network. If we choose to go out of network, we have a lifetime maximum of $2,000,000.

Preventative Care Benefits: Preventative care under our plan has its own set of benefits and is determined by the age of the family member being treated. For any family member, preventative care visits are covered by the $15 office visit copays. Children under age 3 are limited to $500 per calendar year. Family members over age 3 receive one preventative care visit per year. Immunizations are included with the preventative care visits. For children under age 3, immunizations are not subject to a maximum. For children and other family members over age 3 they are subject to the $500 annual maximum mentioned above. All of this is for in network providers. Annual physicals and immunizations are not covered if performed by an out of network provider. Routine mammograms, pap smears, and PSA testing, and occult blood screening are covered as above until the $500 annual maximum has been met. At that point the expenses are subject to our plan deductible of $5000 and 10% coinsurance.

Prescription Drug Benefits: We have two options for having prescription drugs filled: in the pharmacy or by mail service. When having prescriptions filled in the pharmacy, we pay $15, $30, or $45, depending on the drug. This is for a 31 day supply. When mailing in prescriptions to be filled, we pay $37.50, $75, or $112.50 for a 90 day supply, again depending on the drug.

Other Benefits: We do not have dental insurance with our plan and the only vision coverage we have is one exam each year, for which we pay the $15 office visit copay. Human organ and tissue transplants are covered with $15 office visit copays, and our standard plan deductible and coinsurance. This is only at a United Resource Network facility. This is no coverage at other facilities. Home health expenses are covered under our $5000 deductible and 10% coinsurance with a 180 day maximum per year and a 16 hour maximum per day. Hospice and bereavement counseling are covered at 90% after we have met our deductible.

Overall this United Healthcare plan is really good. The deductible is a little high, but the coverage were getting is quality coverage. And flexible. I hope we can keep our United Healthcare in the coming years or go back on UnitedHealthOne. I had Blue Cross Blue Shield before and I don’t want coverage like that again.



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